Chemotherapy is an important treatment for some types of primary bone cancer. It is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

Chemotherapy drugs are sometimes given as tablets or, more usually, by injection into a vein (intravenously). Sometimes, to make this easier and to avoid you having to have frequent injections, a fine plastic tube (called a central line) can be put into a vein in your chest. The line is put in under a general or local anaesthetic.

Instead of a central line, a tube may be put into a vein in the crook of your arm: this is known as a PICC (Peripherally inserted central catheter) line. A tube with an injectable port just under the skin may sometimes be used: this is known as an implantable port.

A session of chemotherapy treatment usually lasts a few days. This is followed by a rest period of a few weeks to allow your body to recover from any side effects of the treatment. The number of sessions you have will depend on the type of bone cancer you have and how well it is responding to the drugs.

Chemotherapy will usually mean spending a few days in hospital. Sometimes it may be given to you as an outpatient. In this situation it is given continuously into a vein through a central line or PICC line. The dose is controlled by a small portable pump.

Depending on the type of bone cancer you have, your doctor may recommend a course of chemotherapy before you have surgery or radiotherapy. This can shrink the tumour and make it easier to remove. It can also reduce symptoms such as pain and reduce the chances of the cancer spreading. Treatment given before an operation is known as neo-adjuvant therapy.

If you have an osteosarcoma or Ewing’s sarcoma you will have more chemotherapy after surgery or radiotherapy. This is to destroy any remaining cancer cells and prevent the sarcoma from spreading outside the bone. This is known as adjuvant chemotherapy and it is given because research has shown that tiny amounts of cancer may be present (especially in the lungs), which are too small to be detected by a scan.

Before having chemotherapy you will have some tests to check how well your heart, liver and kidneys are working. This will usually involve blood tests. In order to check your kidneys you may have an injection of a small amount of mildly radioactive liquid into one of your veins. The radioactive liquid is passed out in your urine. A few hours after the injection, blood tests are taken.

You may have an electrical trace taken of your heartbeat (an ECG) or a scan of your heart in which the doctor can see your heart beating.

Your doctor will discuss the results of these tests with you. The results are normally available after a few days.

You may be offered chemotherapy treatment as part of a clinical trial. Clinical trials are very important in improving the way that bone cancer is treated. Your doctor or research nurse can discuss any relevant trials with you.

Chemotherapy can sometimes cause unpleasant side effects. Any side effects that occur are usually temporary and can often be well controlled with medicines. The main side effects are described here, with tips on ways of avoiding or reducing them.

Lowered resistance to infections While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal cells in your blood. When these cells are reduced you are more likely to get an infection and you may tire easily. During chemotherapy your blood will be tested regularly and, if necessary, you may be given antibiotics to treat any infection. Medicines called growth factors may also be given to stimulate the production of white blood cells by the bone marrow and reduce the chance of you getting an infection.

If your temperature goes above 38ºC (100.5ºF), or you suddenly feel unwell, even with a normal temperature, contact your doctor or the hospital straight away.

Anaemia If the level of red blood cells (haemoglobin) in your blood is low you will become very tired and lethargic. You may also become breathless. These are all symptoms of anaemia – a low level of haemoglobin in the blood. Anaemia can be very successfully treated by blood transfusions. You will feel more energetic and the breathlessness will be eased.

Bruising and bleeding Platelets are a type of cell that help to clot the blood. If the number of platelets in your blood is low you will bruise very easily, may develop blood spots (petechiae) or rashes (purpura), and may bleed heavily from even minor cuts or grazes. If you develop any unexplained bruising or bleeding, contact your doctor or the hospital immediately. We have information on platelet transfusions.

Feeling sick Some of the drugs used to treat primary bone cancer may make you feel sick (nauseated) and possibly make you vomit. There are now very effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce nausea and vomiting. Your doctor will prescribe these for you.

Sore mouth Some chemotherapy drugs can make your mouth sore and cause small ulcers. Regular mouthwashes are important and your nurse will show you how to do these properly. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet.

Hair loss Unfortunately, some, but not all, of the drugs can also cause hair loss. Ask your doctor if the drugs you are having are likely to cause hair loss or other specific side effects. People who lose their hair often cover up by wearing wigs, hats or scarves. Hospital inpatients are entitled to a free wig from the NHS, and your doctor or nurse will be able to arrange for a wig specialist to visit you. However, people being treated as outpatients usually have to pay for their wigs. If your hair falls out due to chemotherapy, it will grow back over 3–6 months.

Although they may be hard to bear at the time, these side effects will disappear once your treatment is over. It is important to remember that chemotherapy affects different people in different ways. Some find that they are able to lead a fairly normal life during their treatment, but many people find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.

Fertility Your ability to become pregnant or father a child may be affected by some of the chemotherapy drugs used to treat bone tumours. It is important to discuss fertility with your doctor or nurse before starting treatment, as it may be possible for men to store sperm, and for women to store embryos or eggs. We can send you further information about ways of preserving your fertility.

Some women may find that the chemotherapy treatment makes them go into the menopause, and they may have signs of menopause such as hot flushes and sweats. In many cases, replacement hormones (HRT) can be given to replace the hormones that are no longer being produced. You may find it helpful to talk this through with your doctor or a support organisation.

Contraception It is not advisable to become pregnant or father a child while having any of the chemotherapy drugs used to treat bone tumours, as they may harm the developing foetus. Again, you can discuss this with your doctor or chemotherapy nurse.

Our section on chemotherapy discusses treatment and its side effects in more detail. Information on individual drugs and their particular side effects is also available.